Existential Therapy: An Overview for Consumers
By Louis Hoffman, Ph.D.
Existential therapy can easily appear quite frightening, confusing, and even daunting those who knows little about it. Hopefully, this brief overview can begin to take some of the mystery and fear out of the idea of existential therapy. I’ll begin by giving an overview of the primary themes of existential therapy. As a supplement to this overview, I include a brief section on what it is like to be in existential therapy. Last, a summary of some of the common misconceptions of existential therapy is provided. In beginning this venture, it is also important to note that there are many approaches to existential therapy and this reflects just one of many perspectives.
Central Themes of Existential Therapy
Why People Enter Existential Therapy
Life is painful. There is no way to be truly and authentically alive without experiencing pain. However, it is often human nature for us to try to avoid or manage this pain. Many approaches to therapy attempt to make a distinction between the “mentally ill” and people who are “normal” or “healthy.” Existential therapists typically don’t draw lines in the sand trying to determine who is healthy and who is not. Rather, we are all seen as being on the same continuum and the same journey.
Yalom (1989) used the world “existence pain” to get at the essence of the problems in human living. Because we all deal with this pain differently, it is experienced in various ways. For example, some people may be prone to experiencing their existence pain as depression while others may be prone to experience it as anger, anxiety, or a variety of other symptoms. While some existential therapists still use diagnosis to help focus treatment, conceptualize what is happening with the individual, or provide information required for the consumer to receive insurance benefits; typically, they bring with them a very different understanding of what that diagnosis means.
This understanding of existence pain helps the therapist stay focused on the individual as a hurting and/or growing person, not a diagnosis or a problem to be solved. Therapy is seen as being about personal growth as well as about reducing suffering. The growth can both help alleviate suffering and bring a different understanding about the meaning of the pain.
Focus of Existential Therapy
The focus of treatment in existential therapy is determined between the therapist and the consumer. In some approaches to therapy, the therapist is seen as the knower or authority and should determine the course of treatment. In existential therapy, the consumer is seen as being an expert, too. They are an expert on their experience (confusing as it may be at times) and are in a better position to determine what they would like to accomplish through therapy. The therapist is a guide with whose expertise is in guiding individuals where they want to go, not determining their direction for them.
Existential therapy tends to focus on issues of 1) self-awareness; 2) relationships; 3) human limitation (things that are beyond our control and knowledge); 4) freedom, responsibility; and choice; and 5) meaning. How these issues are dealt with varies greatly from individual to individual. Flexibility is paramount in existential therapy. No two therapies (or therapists) are like. Or, as Yalom (2002) states, a new therapy needs to be created with each new client-therapist relationship.
From the context of these themes, a major component of the existential therapy process is self exploration. How the particular exploration occurs depends largely on the individual issues and the consumer. Typically, this will include an exploration of patterns which develop in the therapy relationship along with an examination of other patterns in the consumer’s life and past. The exploration process allows for the client to bring new meaning and experiences to what is discovered.
What is it Like to be in Existential Therapy?
If you are interested in what it is like to be in existential therapy, I highly recommend three books written by Irving Yalom, a long time existential therapist. Each of these books contains stories about actual therapy experiences. They were written for both therapists and consumers of existential therapy.
Every Day Gets a Little Closer (1990) was written with Ginny Elkin, who was in therapy with Yalom. The book consists of notes about the therapy experience from both of their perspectives. Love’s Execution (1989) provides a brief overview of existential theory in the introduction and then contains 10 of Yalom’s case histories. Last, Momma and the Meaning of Life (1999) offers a mix case histories and fictional tales about psychotherapy.
In existential therapy, a client can expect a variety of experiences. First, they can expect for their therapist to attempt to join them in a genuine relationship. The therapy relationship is seen as a primary aspect of the healing and growth. In this relationship, the therapist is responsible for assuring the maintenance of appropriate boundaries while also guiding the consumer to a deeper understanding of their relationships and their way of relating to others. So the first thing a client can expect is to be cared for, cared about, and related to as a real person.
Additionally, consumers can expect to gain a deeper awareness of themselves. Many aspects of therapy focus on the development of this new knowledge. First, the client is encouraged to explore themselves with the assistance of the therapist’s guidance. Second, the therapist will assist the client in developing new way to explore their experiences. Third, therapists will offer reflections from a different vantage point, interpretations, and new references for understanding their experience. Finally, as mentioned previously, the therapists will explore the nuances of the therapy relationship to assist in the self-awareness process.
Learning about oneself is not always easy. Consumers will encounter some pain along the way. It is very natural for people to resist the growth and awareness in therapy. In fact, it may be unhealthy if this process never occurs. When resistance comes up, it is important for this to be explored together to promote a deeper understanding of the meaning of the resistance. A third experience clients can expect is to encounter resistance and pain, as well as increased joy and life satisfaction.
Typically, a variety of emotions about the therapist and the therapy process will emerge in therapy. Some of these don’t make sense and may even appear inappropriate. It is important for these, too, to be discussed with the therapist. In this process, it is the therapist’s responsibility to assure appropriate boundaries are always kept and the client’s responsibility to explore the feelings that emerge through the therapy process.
Last, a brief note on the length of treatment should be made. It is always difficult to estimate the length of treatment because it varies greatly from individual to individual. Typically, existential therapy will last at least 6 months and often extend up to 2-3 years. However, it may be shorter or longer depending upon the consumer and the issues being dealt with in therapy.
Misconceptions about Existential Therapy
Misconception 1: Existential therapy is based on deep, intellectual conversations which are difficult to follow. It is easy to understand why people are intimidated by existential therapy. Often, people assume you have to be a highly intelligent, well-read individual to be able to participate in existential therapy. If you skim through many of the books with “existential” in the title, you will quickly understand how this misconception developed. Existential therapists adapt the consumer’s language, not vice versa. Additionally, the focus is on the therapist meeting the client where they are at.
Misconception 2: Existential therapy is agnostic, atheistic, or anti-religion. There are therapists and theorists from all the major approaches to psychotherapy who tend to be hostile toward religion. Existential therapy is no exception. However, there are also many existential therapists who are very committed religious/spiritual individuals and believe that religious beliefs are an important aspect of the individual. The majority of existential therapists are respectful and supportive of their client’s beliefs. If this is an issue you are concerned about, it is important to talk with your therapist about this upfront (regardless of their approach to therapy).
Misconception 3: Existential therapy takes a pessimistic view of human nature. While many existential therapists and philosophers write about the negative side of the human experience, existential therapists typically actually have an optimistic view of human nature. In theory and therapy, existential therapists tend to believe it is important to deal both with the positive and negative aspects of human existence.
Misconception 4: Existential therapy is overly focused on the individual. Again, this can be an understandable misconception reading some of the existential literature. However, in reality, most existential therapists are profoundly relationally focused. They deal both with the individual in isolation and the individual in relationship.
Conclusion
Existential therapy is a dynamic, flexible approach to therapy which focuses on the therapy relationship and the individual needs of the consumer. Blending an optimistic view of human potential with a realistic conception of human limitation, therapists avoid many of the typical labels or understandings of people as being pathological or mentally ill. Rather, all people are seen as having to deal with existence pain and the need to find their own way accomplishing this.
References
Yalom, I. D. (1989). Love’s executioner. New York: Basic Books.
Yalom, I. D. (1999). Momma and the meaning of life. New York: Perennial.
Yalom, I. D. (2002). The gift of therapy. New York: HarperCollins.
Yalom, I. D. & Elkin, G. (1990). Every day gets a little closer: A twice told therapy. New York: Basic Books.
APA Reference Citation Information:
Hoffman, L. (2005). Existential therapy: An overview for consumers. Retrieved from http://www.depth-psychotherapy-network.com/Consumer_Section/Orientation_Overviews/Existential%20Psychotherapy/Hoffman_Overview.htm
Author Bio
Dr. Hoffman is a practicing existential psychotherapist. He has developed a website on existential psychotherapy (www.existential-therapy.com) which provides a more extensive overview of the theory, resources, and training opportunities. Dr. Hoffman is a faculty member of Vanguard University in Costa Mesa, California and also teaches at the Center for Existential Depth Psychology in Los Angeles and Argosy University, Orange County. Dr. Hoffman is also an editor and contributor to the new book, Spirituality and Psychological Health.